Transcription

1 Page 1 of 8 Profile - PA General Disclaimer: The information posted on the Healthcare Professions Profile Program (HPPP) website was provided by applicants for an original license; applicants for reinstatement or reactivation of an existing license; as well as by those individuals renewing a license. While the Division believes the information to be reliable, human or mechanical error remains a possibility, as does the delay in the posting or updating of information. The Division makes no guarantee as to the accuracy or completeness of the information and the information is not verified by the HPPP staff. The Division will take action to obtain compliance with the requirements to provide accurate and timely information as required by law when information is received that indicates information required by law has not been provided or is not accurate. Availability Disclaimer: Healthcare professionals who have an inactive or lapsed license are not required to complete a Healthcare Professions Profile until they apply for reactivation or reinstatement. If you have questions about a missing Healthcare Professions Profile or any missing documents that should be listed, please contact the Healthcare Professions Profile Program at dora_dpo_hppp@state.co.us or Malpractice Claims Disclaimer: Some studies have shown that there is no significant correlation between malpractice history and a healthcare professional's competence. At the same time, consumers should have access to malpractice information. To make the best healthcare decisions, you should view this information in perspective. You could miss an opportunity for high quality care by selecting a healthcare professional based solely on malpractice history. When considering malpractice data, please keep in mind: Malpractice histories tend to vary by profession and by specialty. Some professions or specialties are more likely than others to be the subject of litigation. You should take into account how long the healthcare professional has been in practice when considering malpractice averages. The incident causing the malpractice claim may have happened years before a payment is finally made. Sometimes, it takes a long time for a malpractice lawsuit to move through the legal system. Some healthcare professionals work primarily with high-risk patients. These healthcare professionals may have malpractice histories that are higher than average because they specialize in cases or patients who are at very high risk for problems. Settlement of a claim may occur for a variety of reasons that do not necessarily reflect negatively on the professional competence or conduct of the healthcare professional. A payment in settlement of a malpractice action or claim should not be construed as creating a presumption that malpractice has occurred. You may wish to discuss information provided, and malpractice generally, with your healthcare professional. Name Credential Tiffany Renee Carter PA HPPP - PA Introduction Healthcare Professions Profile Please be aware that this profile is only for your Physician Assistant license. Do not provide information for other license types you hold on this profile. You will be required to complete a profile for every license you hold that is included in the profiling requirement. All information provided in this profile must be updated within 30 days of any change of information unless your profession's statute says otherwise, or unless the question specifies otherwise. HPPP GLOBAL - Location of Practice Location of Practice Are you currently practicing in the healthcare profession associated with this profile? HPPP GLOBAL - WF Location of Practice If Yes Location of Practice Practice Locations: Address City State Zip Code Phone Number

2 Page 2 of 8 HPPP - PA Education and Training Education and Training School or Education Level: Texas Tech University Please enter the year your initial Degree was achieved: Only enter the year in YYYY format 2014 HPPP GLOBAL - Other Licenses Other Licenses Have you ever held, or do you currently hold any other licenses in this profession from any other state, country or province? Yes HPPP GLOBAL - Other Licenses if Yes Other Licenses Other Licenses: State License Status Year Originally Issued Texas Active 2015 HPPP GLOBAL - Board Certifications Board Certifications Do you hold any current Board Certifications? Yes HPPP - PA Board Certifications if Yes Board Certifications Board Certifications: Certification Other HPPP GLOBAL - Practice Specialties

3 Page 3 of 8 Practice Specialties Do you have a practice specialty in which you are appropriately trained and actively practicing? Yes HPPP - PA Practice Specialties if yes Practice Specialties Practice Specialties: Specialty Other HPPP GLOBAL - CO Hospital Affiliations Colorado Hospital Affiliations Do you have a current affiliation or clinical privileges with any Colorado Hospital? HPPP GLOBAL - CO Hospital Affiliations if Yes Colorado Hospital Affiliations Colorado Hospital Affiliations: Hospital Affiliation Type City HPPP GLOBAL - Other Hospital Affiliations Other Health Care Facilities and Out of State Hospital Affiliations Do you have a current affiliation with any healthcare facility or a non-colorado hospital? Yes HPPP GLOBAL - Other Hospital Affiliations If Yes Other Health Care Facilities and Out of State Hospital Affiliations Other Healthcare Facility Affiliations: Facility Affiliation Type City State Odessa Regional Medical Center Other Odessa Texas HPPP GLOBAL - Business Ownership

4 Page 4 of 8 Business Ownership Do you have a current business ownership interest in any healthcare-related business? HPPP GLOBAL - Business Ownership if Yes Business Ownership Business Ownership: Business Name City State HPPP GLOBAL - Employer Employer Do you have an employer in the profession in which you are licensed or are applying for a license? HPPP GLOBAL - Employer if Yes Employer Employer: Employer Name Address City State Zip Code Phone Number HPPP GLOBAL - Employment Contracts Employment Contracts Do you have a contract with any business whose mission relates to healthcare services or products where the value is greater than $5000 annually? HPPP GLOBAL - Employment Contracts if Yes Employment Contracts Employment Contracts: Entity Name Length of Contract Contract Position HPPP GLOBAL - Disciplinary Actions

5 Page 5 of 8 Disciplinary Actions Have you ever had public disciplinary action taken against your license by any board or licensing agency in any state or country? HPPP GLOBAL - Disciplinary Actions if Yes Disciplinary Actions Disciplinary Actions: Discipline Year State HPPP GLOBAL - Restrictions and Suspensions Restrictions and Suspensions Have you ever entered into any agreement or stipulation to temporarily cease your practice or had a board order issued restricting or suspending your license? HPPP GLOBAL - Restrictions and Suspensions if Yes Restrictions and Suspensions Restrictions and Suspensions: Restriction Year State HPPP GLOBAL - Healthcare Facility Actions Healthcare Facility Actions Since September 1, 1990, have you had any final actions resulting in involuntary limitations or probationary status on or reduction, nonrenewal, denial, revocation or suspension of medical staff membership or clinical privileges at a hospital or healthcare facility? You are not required to report a precautionary or administrative suspension unless you resigned your medical staff membership or clinical privileges while the suspension was pending. HPPP GLOBAL - Healthcare Facility Actions if Yes Healthcare Facility Actions Healthcare Facility Actions: Facility Name City State Type of Action Year of Action Duration Terms Complete

6 Page 6 of 8 HPPP GLOBAL - Termination of Employment Termination of Employment Have you ever been terminated by an employer for a reason that would be considered a violation of your profession's practice law? HPPP GLOBAL - Termination of Employment if Yes Termination of Employment Terminations: Employer Name Termination Date HPPP GLOBAL - DEA Registration DEA Registration Surrender Have you ever had to involuntarily surrender your United States Drug Enforcement Agency Administration Registration? HPPP GLOBAL - DEA Registration if Yes DEA Registration Surrender Year of Surrender: HPPP GLOBAL - Convictions Convictions Since you were issued a license to practice your profession in any state or country, have you had any final criminal conviction(s) or plea arrangement(s) resulting from the commission or alleged commission of a felony or crime of moral turpitude in any jurisdiction? HPPP GLOBAL - Convictions if Yes Convictions Convictions: Year State Jurisdiction

7 Page 7 of 8 HPPP GLOBAL - Malpractice Claims Malpractice Claims Since September 1, 1990, have you had any final judgment, entered into a settlement, or paid an arbitration award for malpractice? HPPP GLOBAL - Malpractice Claims if Yes Malpractice Claims Malpractice Claims: Year State Claim Type Arbitrator, Mediator or Court HPPP GLOBAL - Malpractice Carrier Refusal Malpractice Carrier Refusal Have you been denied liability insurance, or has your liability insurance coverage been limited, restricted or terminated by the insurance carrier? HPPP GLOBAL - Malpractice Carrier Refusal if Yes Malpractice Carrier Refusal Malpractice Carrier Refusal: Carrier Refusal Year HPPP GLOBAL - Optional Narrative Optional Narrative Optional Narrative: I have recently renewed privilages with Odessa Regional Medical Center - however these privilages were under the supervision of J. B. Naidu and Vikram Vadyala which I am no longer employed with. I practiced in Internal Medicine but have not completed a speciality program. As a physician assistant I am trained in general medicine. I am certified by the NCCPA Psi - Chi Honor society 2010 Named the student in Psychology at the university of Texas of the Permian Basin 2010 Graduated Summa Cum Laude with Bachelors of Arts- Psychology HPPP GLOBAL - Attestation Attestation By submitting this Healthcare Professions Profile to the Division of Professions and Occupations you are attesting that:

8 Page 8 of 8 You are the person identified in this profile; or You are authorized to submit information on behalf of the person identified in this profile; and The information contained herein is true and correct to the best of my knowledge. Submission Date: 06/24/2017 Review Please make sure to PRINT THIS SCREEN for your records. To do so, you can click the button in the upper right hand corner of this screen labeled "Print Review". You will not be able to print after you leave this review screen.